Redmond Elaine J, Nadeau Genevieve, Tu Le-Mai, Doiron R Christopher, Steele Stephen S, Herschorn Sender, Locke Jennifer A, Maciejewski Conrad C, Dwyer Neil T, Campeau Lysanne, Carlson Kevin V, Rourke Keith F
Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
Division of Urology, Université Laval, Quebec, Canada.
Urology. 2021 Feb;148:280-286. doi: 10.1016/j.urology.2020.09.045. Epub 2020 Nov 10.
To assess postoperative outcomes from the Adjustable TransObturator Male System (ATOMS) and identify factors influencing failure to achieve continence.
A multicentered analysis was performed on all patients treated for postprostatectomy incontinence using the third-generation ATOMS at 9 Canadian tertiary referral centers. The primary outcome was continence (defined as requiring ≤1 pad postoperatively for patients requiring ≥2 pads preoperatively and 0 pads for those requiring 1 pad preoperatively). Secondary outcomes included improvement (>50% change in pad use), patient satisfaction, explantation, and postoperative complications.
Two hundred and eighty nine patients with a mean age of 68.9 years were analyzed. Pre-operatively mean pad per day use was 4.2 (1-12), 31.5% of patients reported severe incontinence (≥5 pads/day), 33.9% had concurrent radiotherapy and 19.4% had failed previous incontinence surgery. Overall continence rate was 73.3% (n = 212) at a mean follow-up of 19.6 months. More than eighty nine percent (89.3%) (n = 258) of patients experienced >50% improvement, 84.4% (n = 244) of patients were satisfied with the results of surgery. More than seven percent (7.9%) (n = 23) required device explantation. On multivariate Cox regression analysis, concurrent radiotherapy (hazard ratio [H.R.] 2.3, P < .001), diabetes (H.R. 2.2, P = .007) and increased pre-operative pad usage (H.R. 1.1, P = .02) were each associated with failure to achieve continence, while patient age (P = .60), obesity (P = .08), prior urethral stenosis (P = .56), and prior incontinence surgery (P = .13) were not. Radiation therapy was also associated with device explantation (H.R. 2.7, P = .02).
ATOMS is a safe and efficacious for treatment of postprostatectomy incontinence. However, patients with prior radiation, increased pre-operative pad use, or diabetes are less likely to achieve continence.
评估可调节经闭孔男性系统（ATOMS）的术后效果，并确定影响控尿未成功的因素。
对加拿大9家三级转诊中心使用第三代ATOMS治疗前列腺切除术后尿失禁的所有患者进行多中心分析。主要结局是控尿（定义为术前需要≥2片尿垫的患者术后需要≤1片尿垫，术前需要1片尿垫的患者术后需要0片尿垫）。次要结局包括改善情况（尿垫使用量变化>50%）、患者满意度、取出装置以及术后并发症。
分析了289例平均年龄为68.9岁的患者。术前平均每天使用尿垫4.2片（1 - 12片），31.5%的患者报告有严重尿失禁（≥5片/天），33.9%的患者同时接受了放疗，19.4%的患者既往尿失禁手术失败。平均随访19.6个月时，总体控尿率为73.3%（n = 212）。超过89.3%（n = 258）的患者改善情况>50%，84.4%（n = 244）的患者对手术结果满意。超过7.9%（n = 23）的患者需要取出装置。多因素Cox回归分析显示，同时接受放疗（风险比[H.R.] 2.3，P <.001）、糖尿病（H.R. 2.2，P =.007）和术前尿垫使用量增加（H.R. 1.1，P =.02）均与控尿未成功相关，而患者年龄（P =.60）、肥胖（P =.08）、既往尿道狭窄（P =.56）和既往尿失禁手术（P =.13）则无关。放疗也与取出装置相关（H.R. 2.7，P =.02）。
ATOMS治疗前列腺切除术后尿失禁安全有效。然而，既往接受过放疗、术前尿垫使用量增加或患有糖尿病的患者控尿成功的可能性较小。
